SCHOLARSHIP APPLICATION

MAIL the application by February 29, 2008 to:

Latino Leadership Project Scholarship Program

Scholarship Program Administrators

c/o Judith Calica

55 East Washington Street, #3300

Chicago, IL 60602

Applicant information:

NAME:  

MALE:            FEMALE:

PERMANENT MAILING ADDRESS:

CITY: ZIP CODE:

HOME PHONE NUMBER:

ALTERNATE PHONE NUMBER:

E-MAIL ADDRESS:

HIGH SCHOOL:

ADDRESS:

CITY: ZIP CODE:

HIGH SCHOOL COUNSELOR’S NAME & PHONE NUMBER:

Class Rank:   No. in Class:  

Did you take the SAT?:    Verbal Score:

Math Score: ACT Composite: Grade Point Average:

HOW DID YOU HEAR ABOUT THE LATINO LEADERSHIP PROJECT PROGRAM?

GUIDANCE COUNSELOR WEB SITE SCHOLARSHIP DIRECTORY OTHER

PLEASE CHECK IF YOU ARE A FIRST GENERATION STUDENT TO ATTEND COLLEDE OR

UNIVERSITY:

APPLICANT’S PLACE OF BIRTH:

DATE OF BIRTH:

FATHER'S NAME: 

 OCCUPATION:     

MOTHER'S NAME:

OCCUPATION:     

Number of brothers/sisters: younger older . 

Number in college or vocational school:

What college or vocational school do you plan to enter?

Have you been accepted? Yes: No:

For what career are you preparing?

Have you applied for any other financial aid? Yes: No:

If “Yes”, for what?

List the following:

School Activities (e.g. athletics, clubs)

 

Community activities (e.g. church, volunteer jobs, clubs)

 

Honors/leadership (e.g. awards, club offices held)

 

Work experience

 

List the two persons whom you have asked to write letters of recommendation:

1.  Name:      ________________________________________________________

                 Address:  _________________________________________________________

        _________________________________________________________

                 Phone:     _________________________________________________________

      Email:   ___________________________________________________________

      Relationship to you:  _________________________________________________

2.   Name:    ___________________________________________________________

                  Address: ___________________________________________________________

                                 ___________________________________________________________

                   Phone:   ___________________________________________________________

       Email:     ___________________________________________________________

       Relationship to you: __________________________________________________

Certification and Authorization

All the information that I have provided in this application and in the enclosed letters is true and complete, to the best of my knowledge.  I certify that I am currently enrolled and in good standing as a senior in high school, applying for enrollment to a two or four year college or university for the academic school year and am eligible to receive scholarships granted under the Program.  I hearby authorize the Latino Leadership Project to use any information contained in this application for the purpose of promoting and publishing the Program, or as legally permitted by law.

Authorization for release of records

To comply with provisions of the Family Educational Rights and Privacy Act of 1974, permission is hearby given to applicant’s school officials to release the applicant’s secondary school record and other requested information for consideration in the Program.

 Applicant’s Signature (required): 

______________________________________Date:_____________

Parent or Guardian (for applicants under 18): ____________________________ Date: _____________

Please attach personal statement on a separate document and attach your transcript and letters of recommendation.

Latino Leadership Project